No description available.

No description available.

No description available.

No description available.

Sepsis is a complicated disorder in which an infection has reached the bloodstream and caused a cascade of events that in time will lead to death. Interventions aimed at identifying sepsis early in its progression are imperative to stopping the process. The purpose of this study is to examine the current state of the literature regarding sepsis screening tools utilized by emergency medical services. A literature review exploring the various tools in place was conducted to see their value in predicting sepsis and secondary what the initiation of a sepsis alert has on the patients’ outcome. Results found included that sepsis screening tools when in place decrease time to identification, decrease time to antibiotics, increase amount of fluid administration, and overall reduce hospital stay and mortality rate. With these findings educational training for EMS providers and the introduction of generalized protocols are of the upmost importance. Further research is needed to be done to create a consistent tool to be used by all EMS agencies that has a validated predictive value of sepsis.

No description available.

No description available.

El trabajo académico titulado "Cuidados de Enfermería a Pacientes con Cetoacidosis Diabética en el Servicio de Emergencia" es de naturaleza secundaria, el objetivo fue identificar los cuidados de enfermería proporcionados en el servicio de emergencia a pacientes con cetoacidosis diabética. La metodología de enfermería basada en la evidencia (EBE) se utilizó en este estudio. La pregunta clínica se realizó siguiendo el esquema PICOT: ¿Cuáles son los cuidados de Enfermería proporcionados a los pacientes con cetoacidosis diabética en el servicio de Emergencia? En este estudio bibliográfico, se emplearon recursos como la biblioteca virtual ALICIA, Google Académico, BVS, Dialnet y SCIELO, de donde se extrajeron diez artículos. Estos artículos fueron posteriormente evaluados mediante la lista de validación propuesta por Gálvez Toro, resultando en la selección de dos artículos. Se optó por una guía de práctica clínica basada en evidencia, utilizando la metodología GRADE Adolpment y la lista AGREE II, donde el nivel de evidencia es IA. Encontrando los siguientes cuidados: Monitoreo periódico cada 4 horas, Controlar los niveles de glucosa en un rango de 140 a 180 mg/dL, Monitoreo continuo de la diuresis en con la posibilidad de colocar una sonda urinaria si es necesario, Administración inicial de NaCl 0,9% a 1000 ml/h para corregir el shock hipovolémico, seguido por NaCl 0,9% a 500 mL/h durante 4 horas y luego continuar a 250 mL/h. Estos cuidados son esenciales para el manejo de la cetoacidosis diabética en el entorno de emergencia. / The academic work entitled "Nursing Care of Patients with Diabetic Ketoacidosis in the Emergency Department" is secondary in nature, the objective was to identify the nursing care provided in the emergency department to patients with diabetic ketoacidosis. Evidence-based nursing (EBN) methodology was used in this study. The clinical question was conducted following the PICOT scheme: What is the nursing care provided to patients with diabetic ketoacidosis in the emergency department? In this bibliographic study, resources such as the ALICIA virtual library, Google Scholar, BVS, Dialnet and SCIELO were used, from which ten articles were extracted. These articles were subsequently evaluated using the validation list proposed by Gálvez Toro, resulting in the selection of two articles. An evidence-based clinical practice guideline was chosen, using the GRADE Adolpment methodology and the AGREE II list, where the level of evidence is IA. Finding the following care: Periodic monitoring every 4 hours, Controlling glucose levels in a range of 140 to 180 mg/dL, Continuous monitoring of diuresis with the possibility of placing a urinary catheter if necessary, Initial administration of NaCl 0.9% at 1000 mL/h to correct hypovolemic shock, followed by NaCl 0.9% at 500 mL/h for 4 hours and then continue at 250 mL/h. This care is essential for the management of diabetic ketoacidosis in the emergency setting.

Thesis (PhD)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: The reperfusion injury after myocardial ischemia is relevant in the clinical setting, after cardiopulmonary bypass for cardiac surgery, after PTCA and stenting and after cardiopulmonary resuscitation. The components of the reperfusion injury considered in this study were myocardial stunning and reperfusion arrhythmias. Calcium antagonists have been shown to be beneficial in attenuating the myocardial reperfusion injury in the in vitro and in vivo laboratory setting (Lamping, Gross 1985, Przyklenk and Kloner 1988, Taylor 1990, Ehring 1992, Gross and Piper 1992). However systemic administration of a dose of calcium antagonist, large enough to attenuate the myocardial reperfusion injury in the clinical setting, would inevitably lead to unwanted systemic side effects of the drug. The aim of this study was to investigate the hypothesis that an adequate dose of verapamil administered timeously, directly into the ischemic myocardium, would attenuate the reperfusion injury, either when administered from the onset of ischemia, or from 3 minutes before reperfusion. The anesthetized open chest porcine model of myocardial ischemia (15 min total LAD occlusion) and reperfusion was employed in this study. A low dose of verapamil (0.5 mg/8mt or 0.0625mg/mt), a high dose of verapamil (2mg/8m or O.25mg/ml), or vehicle (saline) (8ml) was infused over 8 minutes, directly into the LAD coronary artery supplying the ischemic segment. The infusion was started either at the onset of ischemia, or from 3 minutes before reperfusion. The time taken for the various parameters to return to pre ischemic values was compared between the different groups. The results showed that the high dose of verapamil (2mg) attenuated the reperfusion injury both when administered from the onset of ischemia, and when administered from 3 minutes before reperfusion, compared to either the low dose of verapamil, or the saline infusions. The high dose of verapamil groups had a faster recovery of both systolic contractile function and diastolic function and a lower incidence of ventricular fibrillation on reperfusion. There were no systemic effects of verapamil infusion in any of the groups. The clinical setting of cardiac surgery expressly lends itself to the clinical application of this finding. There is direct access to the coronary arteries both before ischemia and before reperfusion. A small dose of calcium channel blocking drug, with no systemic effect can be administered into the aortic root at the onset of ischemia, just prior to cardioplegia (when the heart is still warm), and after rewarming a few minutes prior to removal of the aortic cross clamp. / AFRIKAANSE OPSOMMING: Die reperfusie besering na miokardiale isgemie is klinies relevant na kardiopulmonêre omleiding vir hart chirurgie, na kardiologiese PTKA en stut prosedures en na kardiopulmonale ressussitasie. Die komponente van die reperfusie besering wat in hierdie studie oorweeg is, is miokardiale tydelike omkeerbare onderdrukking (stunning) en reperfusie arritmieë. Kalsium antagoniste is gewys om effektief te wees in beperking van die reperfusie besering in beide in vitro en in vivo laboratorium eksperimente (Lamping, Gross 1985, Przyklenk en Kloner 1988, Taylor 1990, Ehring 1992, Gross en Piper 1992). Sistemiese toediening van 'n dosis kalsium kanaal blokker, voldoende om die miokardiale reperfusie besering in die pasiënt te beperk, lei egter tot ongewenste sistemiese newe effekte van die middel. Die doel van die studie was om die hipotese te ondersoek dat 'n voldoende dosis verapamil, wat betyds direk toegedien is aan die isgemiese miokardium, die reperfusie besering sal beperk, ongeag of dit toegedien is vanaf die begin van isgemie, of van 3 minute voor reperfusie. Die vark model van miokardiale isgemie en reperfusie is aangewend in die studie. Die varke was tydens die eksperiment onder narkose, met die borskas oop, en 15 minute totale LAD okklusie is toegepas. 'n Lae dosis verapamil (0.5mg/8ml of 0.0625 mg/mt), of hoë dosis veraparnil (2mg/8mt of 0.25mg/mt), of saline (8mt) is oor 8 minute toegedien direk in die LAD arterie wat die isgemiese segment voorsien. Die infuus is begin direk na die aanvang van isgemie, of 3 minute voor die aanvang van reperfusie. Die tyd geneem vir terugvoer van parameters na pre isgemiese waardes is tussen die groepe vergelyk. Die resultate toon dat die hoë dosis veraparnil die reperfusie besering beperk in vergelyking met die lae dosis veraparnil of saline infusies, ongeag of dit van die begin van isgemie, of van 3 minute voor reperfusie toegedien word. Die groepe wat die hoë dosis veraparnil ontvang het, het vinniger herstel van sistoliese en diastoliese funksie getoon en het'n laer insidensie van reperfusie disritmieë, gewys. Geen sistemiese effekte van veraparnail infuus is waargeneem nie. Die kliniese toepassing van hierdie bevinding is by uitstek geskik vir toepassing tydens kardiopulmonale omleiding by kardiale chirurgie. Daar is direkte toegang tot koronêre arteries voor isgemie en voor reperfusie. 'n Klein dosis kalsium antagonis, met weglaatbare sistemiese effekte, kan toegedien word in die aorta wortel met die aanvang van isgemie, net voor kardioplegie toediening (hart steeds warm), en na verwarming, 'n paar minute voor verwydering van die aorta kruis klem.

Thesis (M.Tech.: Emergency Medical Care)-Durban University of Technology, 2007 xiv, 116 leaves / The Professional Board for Emergency Care Practitioners (PBECP), a division of the Health Professions Council of South Africa, regulates the scope of practice and publishes guidelines and protocols that advanced life support (ALS) practitioners are required to follow. These define an acceptable, standardised approach to each commonly encountered emergency. Non compliance with the guidelines and protocols regularly occurs, which could impact on the quality of care delivered and may result in further injury or death of the patient. This study investigated the reasons for non-compliance by ALS practitioners and explored how compliance could be improved.